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Case Report
The importance of differential diagnosis between Bronj and hematologic diseases R. Bonacina1, V. Martini1, P. Schiavone2, U. Mariani1, A. Rambaldi2 1 Department of Dentistry, Ospedale Papa Giovanni XXIII, Bergamo; 2 Department of Hematology, Ospedale Papa Giovanni XXIII, Bergamo, Italy Introduction. The oral cavity may represent the initial site involved in systemic diseases. A number of systemic diseases have manifestations in the oral cavity, in some cases representing the initial sign1. The clinician should recognize these manifestations in order to formulate differential diagnostic hypotheses. Case Report. A 78-year-old woman was referred to our department by her physician for suspected bisphosphonate associated osteonecrosis of the jaw. The patient, affected by rheumatoid arthritis, had been treated with alendronate and per os in the last 5 years and presented an area of exposed bone in the maxilla persisting for more than 8 weeks. Annali di Stomatologia 2013; Suppl. 2: 1-48
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After a careful clinical and radiographic inspection the hypothesis of hematologic disease came out as well2. Multiple biopsies of bone tissue and surrounding mucosa were performed. The histopathological examination revealed a large B-cell lymphoma. Thanks to the correct and prompt diagnosis the patient was referred and treated in the department of Hematology. Follow-up carried out in our department showed the progressive and complete healing of the exposed bone. Discussion. The differential diagnosis is a fundamental step in the evaluation of patients, representing the summary of medical history, reported symptoms and objective signs detected during clinical inspection. In the clinical practice the formulation of differential diagnostic hypothesis3 should address the clinician to perform further investigations in order to correctly identify the patient’s disease thus ensuring the best treatment. References 1. 2. 3.
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Zadik, et al. Primary lymphoma of the mandible masquerading as bisphosphonate-related osteonecrosis of jaws. Quintessence Int 2012 Oct; 43(9):769-75. Baur Da, et al. Osteonecrosis of the jaws unrelated to bisphosphonate exposure: a series of 4 cases. J Oral Maxillofac Surg 2012 Dec; 70(12):2802-8. Almazrooa SA, Woo SB. Bisphosphonate and nonbisphosphonate-associated osteonecrosis of the jaw: a review. J Am Dent Assoc 2009 Jul; 140(7):864-75.
Annali di Stomatologia 2013; Suppl. 2: 1-48
Case Report
The importance of differential diagnosis between Bronj and hematologic diseases R. Bonacina1, V. Martini1, P. Schiavone2, U. Mariani1, A. Rambaldi2 1 Department of Dentistry, Ospedale Papa Giovanni XXIII, Bergamo; 2 Department of Hematology, Ospedale Papa Giovanni XXIII, Bergamo, Italy Introduction. The oral cavity may represent the initial site involved in systemic diseases. A number of systemic diseases have manifestations in the oral cavity, in some cases representing the initial sign1. The clinician should recognize these manifestations in order to formulate differential diagnostic hypotheses. Case Report. A 78-year-old woman was referred to our department by her physician for suspected bisphosphonate associated osteonecrosis of the jaw. The patient, affected by rheumatoid arthritis, had been treated with alendronate and per os in the last 5 years and presented an area of exposed bone in the maxilla persisting for more than 8 weeks. Annali di Stomatologia 2013; Suppl. 2: 1-48
27
Suppl.completo reimpag._4b_. 04/10/13 15:55 Pagina 28
After a careful clinical and radiographic inspection the hypothesis of hematologic disease came out as well2. Multiple biopsies of bone tissue and surrounding mucosa were performed. The histopathological examination revealed a large B-cell lymphoma. Thanks to the correct and prompt diagnosis the patient was referred and treated in the department of Hematology. Follow-up carried out in our department showed the progressive and complete healing of the exposed bone. Discussion. The differential diagnosis is a fundamental step in the evaluation of patients, representing the summary of medical history, reported symptoms and objective signs detected during clinical inspection. In the clinical practice the formulation of differential diagnostic hypothesis3 should address the clinician to perform further investigations in order to correctly identify the patient’s disease thus ensuring the best treatment. References 1. 2. 3.
28
Zadik, et al. Primary lymphoma of the mandible masquerading as bisphosphonate-related osteonecrosis of jaws. Quintessence Int 2012 Oct; 43(9):769-75. Baur Da, et al. Osteonecrosis of the jaws unrelated to bisphosphonate exposure: a series of 4 cases. J Oral Maxillofac Surg 2012 Dec; 70(12):2802-8. Almazrooa SA, Woo SB. Bisphosphonate and nonbisphosphonate-associated osteonecrosis of the jaw: a review. J Am Dent Assoc 2009 Jul; 140(7):864-75.
Annali di Stomatologia 2013; Suppl. 2: 1-48
